内膜下血管成形术治疗股腘动脉硬化闭塞症

Subintimal angioplasty in the treatment of femoropopliteal arteriosclerotic occlusive diseases

目的探讨内膜下血管成形术(SIA)治疗长段股腘动脉硬化闭塞的临床疗效及其技术要点。方法回顾性分析2009年6月～2011年8月我院收治的20例TASCⅡC型、D型股腘动脉硬化闭塞患者的临床资料,采用SIA开通长段闭塞管腔,同时行球囊扩张和支架植入术,以踝/肱指数(ABI)、Fontaine分期、保肢率和通畅率综合评估临床疗效。结果 SIA技术成功率为85%,临床症状改善率为90%,保肢率为95%,一期通畅率为83.3%,ABI从术前0.42±0.07提升至术后0.86±0.14,术前、术后比较差异有统计学意义(P<0.01)。术后随访12～24个月,18例临床症状改善的患者中有3例术后3～6个月症状复发,行第二次介入治疗,其余患者症状均无加重或复发。结论 SIA在治疗股腘动脉硬化闭塞症中具有良好的应用价值,方法安全有效,近期通畅率较好,远期通畅率尚需要进一步随访。

Objective To explore the clinical efficacy and technical points of subintimal angioplasty (SIA) in the treatment of long-segment femoropopliteal arteriosclerotic occlusive diseases. Methods Between June 2009 and August 2011,the clinical data of 20 patients with long-segment TASC Ⅱ type C and type D femoropopliteal arteriosclerotic occlusive diseases were analyzed retrospectively. These patients underwent SIA followed by percutaneous transluminal angioplasty (PTA) and stent implantation. The treatment efficacy was evaluated by ankle brachial index (ABI), Fontaine stages, limb salvage rate and primary patency rate. Results The rate of technical success, clinical improvement, limb salvage and primary patency was 85%,90%,95% and 83.3%, respectively. ABI increased obviously from 0.42±0.07 preoperationally to 0.86±0.14 postoperationally (P<0.01). During the follow-up time of 12-24 months, 3 patients relapsed in 3-6 months after operation, and underwent the second interventional therapy. Clinical symptoms improved and no recurrence was found in the rest of the patients. Conclusion SIA is an effective and safe technique in the treatment of long-segment femoropopliteal arteriosclerotic occlusive diseases with a high short-term patency rate. However, long-term patency rate need to be further evaluated.